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2.
J Ocul Pharmacol Ther ; 37(8): 472-478, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34449255

RESUMO

Purpose: To evaluate the clinical efficacy of switching from cyclosporine A (CsA) 0.05% anionic emulsion (CsA AE) to CsA 0.1% cationic emulsion (CsA CE) in patients with dry eye (DE) associated with Sjögren's syndrome (SS). Methods: Forty patients with SS-associated DE who were unresponsive to CsA AE for 6 months were enrolled. After baseline measurements, the CsA AE was switched to CsA CE. The ocular surface disease index (OSDI), Sjögren's International Collaborative Clinical Alliance (SICCA), and Schirmer's test scores and tear film breakup time (TBUT) were evaluated at baseline and 1 and 3 months after switching. Results: Two patients dropped out, and 38 were analyzed. OSDI and SICCA ocular staining scores were significantly reduced at 1 and 3 months after switching, compared with the baseline scores (all P < 0.01). Although no significant changes were noted in the corneal staining scores (CSSs), patients with higher baseline CSS (≥4) showed an improvement in the scores at 1 month (P = 0.03) and 3 months (P = 0.01) after switching. There were no significant changes in TBUT and Schirmer's test scores during the follow-up periods. Conclusions: In patients with SS-associated DE, switching from CsA AE to CsA CE was effective in improving ocular symptoms and conjunctival staining. In addition, corneal staining was decreased in patients with severe keratitis.


Assuntos
Ciclosporina/uso terapêutico , Emulsões/uso terapêutico , Imunossupressores/uso terapêutico , Síndrome de Sjogren/tratamento farmacológico , Administração Oftálmica , Ânions , Cátions , Ciclosporina/administração & dosagem , Substituição de Medicamentos , Emulsões/administração & dosagem , Feminino , Fluorofotometria , Humanos , Imunossupressores/administração & dosagem , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Síndrome de Sjogren/diagnóstico , Inquéritos e Questionários , Lágrimas/fisiologia , Resultado do Tratamento
3.
Curr Eye Res ; 46(8): 1096-1104, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33588656

RESUMO

PURPOSE/AIM: Dry eye (DE) disease is a multifactorial disease in which uncontrolled inflammation can lead to corneal epithelium lesions and symptoms of discomfort. The aim of the present study was to evaluate the efficacy of two cyclosporine emulsions in a mouse model of DE with corneal epithelium lesions. MATERIALS AND METHODS: Six- to 9-week-old female C57BL/6 N mice were housed in a controlled-environment room to induce DE. Following DE development, mice were instilled with: QD 0.1%CsA cationic emulsion (CaEm), BID 0.05%CsA anionic emulsion (AEm), or left untreated. Aqueous tear production and corneal epithelium lesions were assessed throughout the experiment. At the end of the treatment period, left eyes were sampled, fixed, and stained for histology, while the cornea, conjunctiva, and lacrimal gland of right eyes were sampled for transcriptomic analysis. RESULTS: Corneal lesion scores were reduced by 10.4%, 18.4%, and 10.9% at day 6, 10, and 14, respectively, with CaEm (QD), and by 2.6%, 3.0%, and 5.5% at day 6, 10, and 14, respectively, with AEm (BID). Histology demonstrated that 7 out of 10 DE mice presented moderate to severe ocular lesions, while only 2 and 5 out of 10 mice presented slight to moderate ocular lesions when treated with the CaEm (QD) and AEm (BID), respectively. The transcriptomic profile analysis suggests that a different set of inflammatory genes are modulated in the cornea, conjunctiva, and lacrimal gland upon DE development. In addition, the two emulsions distinctively modulate the gene expression profile. CONCLUSIONS: This study demonstrates that both emulsions were effective at reducing corneal lesions, with the CaEm (QD) being slightly better than the AEm (BID). Interestingly, this study suggests that ocular tissues may not respond similarly to a dry environment and that a different set of genes is modulated by the two formulations in the ocular tissues.


Assuntos
Ciclosporina/administração & dosagem , Modelos Animais de Doenças , Síndromes do Olho Seco/tratamento farmacológico , Emulsões , Imunossupressores/administração & dosagem , Administração Oftálmica , Animais , Túnica Conjuntiva/efeitos dos fármacos , Túnica Conjuntiva/metabolismo , Túnica Conjuntiva/patologia , Córnea/efeitos dos fármacos , Córnea/metabolismo , Córnea/patologia , Síndromes do Olho Seco/metabolismo , Proteínas do Olho/metabolismo , Feminino , Fluorofotometria , Aparelho Lacrimal/efeitos dos fármacos , Aparelho Lacrimal/metabolismo , Aparelho Lacrimal/patologia , Camundongos , Camundongos Endogâmicos C57BL , Soluções Oftálmicas , Conservantes Farmacêuticos , Lágrimas/fisiologia , Transcriptoma , Resultado do Tratamento
4.
Cornea ; 40(4): 462-466, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32732696

RESUMO

PURPOSE: To evaluate longitudinally corneal endothelial cell changes in patients undergoing hematopoietic stem cell transplantation (HSCT) and to further investigate possible correlations with hematological and ocular characteristics. METHODS: Prospective observational study conducted at a single center. All patients underwent a comprehensive ophthalmological examination, before and after HSCT, including slitlamp examination, Schirmer test, tear breakup time, ocular surface staining, specular microscopy of corneal endothelium, and Ocular Surface Disease Index questionnaire. RESULTS: Twenty-five patients undergoing HSCT and 25 age- and sex-matched controls were included. At baseline, hematological patients showed significantly lower values of endothelial cell density (ECD) compared with those of controls (2514.5 ± 390.2 vs. 2723.7 ± 298.0 cells/mm, P = 0.038). After HSCT, ocular surface disease index score significantly increased (P = 0.020) and tear breakup time significantly decreased (P = 0.036). Conversely, no significant changes were found in Schirmer test and corneal fluorescein staining (always P > 0.05). Eight patients (32%) developed ocular graft-versus-host disease (GVHD). ECD values significantly decreased after HSCT (from 2514.5 ± 390.2 to 2409.5 ± 330.9 cells/mm, P = 0.009). The decrease in ECD values after HSCT was more pronounced in patients with ocular GVHD compared with those without (231.1 ± 188.8 vs. 45.6 ± 156.5, P = 0.016). No significant correlations between the changes in ECD and hematological and ocular characteristics were found (always P > 0.05). CONCLUSIONS: Hematological patients showed a lower endothelial cell count already before HSCT, compared with controls. After HSCT, the endothelial cell count further significantly decreased, particularly in patients who developed ocular GVHD.


Assuntos
Doenças da Córnea/etiologia , Endotélio Corneano/patologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Leucemia/terapia , Adulto , Contagem de Células , Doenças da Córnea/diagnóstico , Feminino , Fluorofotometria , Seguimentos , Doença Enxerto-Hospedeiro/diagnóstico , Doença Enxerto-Hospedeiro/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Prospectivos , Microscopia com Lâmpada de Fenda , Inquéritos e Questionários , Lágrimas/fisiologia
5.
Cornea ; 40(2): 168-171, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32467449

RESUMO

PURPOSE: To evaluate the long-term outcomes of surgical occlusion of lacrimal puncta using thermal cautery in the management of ocular surface diseases. METHODS: We reviewed medical records of 80 consecutive patients from a single academic center who underwent punctal cauterization. Patient demographics, ocular history, symptoms, and signs of ocular surface diseases pre- and post-cauterization were recorded. RESULTS: A total of 80 patients (171 puncta) were included, with an average age of 59 years and a follow-up duration of 27 months. The most common ocular morbidity was ocular graft-versus-host disease (n = 36), followed by primary keratoconjunctivitis sicca (n = 15). Indications for punctal cauterization included plug loss (n = 51), difficulty in plug fitting (n = 11), plug-related complications (n = 6), recanalization of previous cauterization (n = 7), and severe ocular surface disease requiring permanent punctal closure (n = 4). After punctal cauterization, the percentage of eyes with severe (21%) and moderate (25%) dry eye decreased significantly (8% and 19% at 3 months and 6% and 17% at 12 months, P = 0.0006). Fifty-four percent of patients reported improvement in their symptoms. The rate of recanalization was 21% during the follow-up period. The use of topical corticosteroids was associated with higher recanalization rate. Associated complications were limited to temporary pain and swelling. CONCLUSIONS: Punctal cauterization is an effective modality in treating severe ocular surface diseases in patients who repeatedly lose punctal plugs, and it can be easily performed in a clinic setting without major complications. However, cauterization may need to be repeated in up to a quarter of cases because of recanalization.


Assuntos
Síndromes do Olho Seco/cirurgia , Eletrocoagulação/métodos , Aparelho Lacrimal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Síndromes do Olho Seco/fisiopatologia , Feminino , Fluorofotometria , Seguimentos , Doença Enxerto-Hospedeiro/fisiopatologia , Humanos , Ceratoconjuntivite Seca/fisiopatologia , Aparelho Lacrimal/fisiopatologia , Masculino , Pessoa de Meia-Idade , Plug Lacrimal , Resultado do Tratamento
6.
Cornea ; 40(4): 445-448, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32826647

RESUMO

PURPOSE: Meibomian glands are subject to regulation by sex hormones. We have now investigated the possible relation between benign prostate hyperplasia (BPH) and meibomian gland dysfunction (MGD). METHODS: Men diagnosed with BPH and receiving treatment with tamsulosin and age-matched male control subjects who attended Itoh Clinic, Saitama, Japan, were enrolled. An ocular symptom score, lid margin abnormality score, and superficial punctate keratopathy score as well as the meiboscore (0-6), meibum grade, breakup time of the tear film, and Schirmer test values were evaluated. Male pattern baldness was also graded according to the Hamilton-Norwood scale. RESULTS: Forty-four eyes of 44 men with BPH (mean age ± SD, 76.1 ± 2.2 years) and 46 eyes of 46 control subjects (mean age ± SD, 75.3 ± 6.2 years) were enrolled. The meiboscore in the BPH group (4.5 ± 1.4) was significantly higher than that in the control group (1.8 ± 1.5, P < 0.0001). Breakup time of the tear film was significantly shorter (3.6 ± 1.7 vs. 5.6 ± 2.5 seconds, P < 0.0001), and Schirmer test value was significantly smaller (9.8 ± 4.8 vs. 13.3 ± 8.0 mm, P = 0.048) in the BPH group than that in the control group. Other ocular parameters did not differ significantly between the 2 groups. The proportion of men with androgenic alopecia was also higher in the BPH group than that in the control group. CONCLUSIONS: BPH was associated with meibomian gland loss and instability of the tear film as well as with the presence of androgenic alopecia.


Assuntos
Disfunção da Glândula Tarsal/fisiopatologia , Glândulas Tarsais/patologia , Hiperplasia Prostática/fisiopatologia , Antagonistas de Receptores Adrenérgicos alfa 1/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Corantes Fluorescentes/administração & dosagem , Fluorofotometria , Humanos , Masculino , Disfunção da Glândula Tarsal/diagnóstico por imagem , Glândulas Tarsais/diagnóstico por imagem , Hiperplasia Prostática/tratamento farmacológico , Coloração e Rotulagem/métodos , Inquéritos e Questionários , Tansulosina/uso terapêutico , Lágrimas/fisiologia
7.
Curr Eye Res ; 46(7): 919-929, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33289602

RESUMO

Purpose: To evaluate the efficacy of a preservative free sodium hyaluronate/chondroitin sulfate ophthalmic solution (SH/CS-PF) in patients with dry eye disease (DED).Methods: This was a randomized phase IV, multicentric, prospective, double-blind clinical trial. Intent-to-treat (ITT) and per-protocol (PP) analyses were performed. Patients were assigned to receive either SH/CS-PF, Systane® Ultra (PEG/PG) or Systane® Ultra PF (PEG/PG-PF) for 90 days. A total of 326 patients were included in the ITT, and 217 in the PP analysis. Efficacy endpoints were goblet cell density, Nelson's grades (conjunctival impression cytology), tear break-up time (TBUT), Ocular Surface Disease Index (OSDI), and Schirmer's test. Other parameters included were tolerability, measured by the ocular symptomatology; and safety, measured through corneal staining, intraocular pressure, visual acuity and adverse events.Results: In the ITT, there was a significant increase in mean goblet cell density in all treatments compared with their baseline (28.4% vs 21.4% and 30.8%), without difference between arms (p = .159). Eyes exposed to SH/CS-PF, PEG/PG and PEG/PG-PF showed Grade 0-I squamous metaplasia (85.5%, 87.9% and 93.2%, respectively). Similar improvements were observed for TBUT (1.24 ± 2.3s vs 1.27 ± 2.4s and 1.39 ± 2.3s) and OSDI scores at day 90 (-8.81 ± 8.6 vs -7.95 ± 9.2 and -8.78 ± 9.8), although no significant intergroup difference was found. Schirmer's test also presented improvement compared to baseline (1.38 ± 4.9 vs 1.50 ± 4.7 and 2.63 ± 5.9), with a significantly higher variation for PEG/PG-PF. There were no significant differences between treatments for any tolerability and safety parameter, nor between ITT and PP analyses for any outcome.Conclusions: The topical application of SH/CS-PF is as effective, safe and well tolerated as that of PEG/PG or PEG/PG-PF. The results suggest that SH/CS-PF may lead to normalization of clinical parameters and symptom alleviation in patients treated for DED.


Assuntos
Sulfatos de Condroitina/administração & dosagem , Síndromes do Olho Seco/tratamento farmacológico , Ácido Hialurônico/administração & dosagem , Administração Oftálmica , Adulto , Idoso , Idoso de 80 Anos ou mais , Sulfatos de Condroitina/efeitos adversos , Método Duplo-Cego , Combinação de Medicamentos , Síndromes do Olho Seco/fisiopatologia , Feminino , Fluorofotometria , Humanos , Ácido Hialurônico/efeitos adversos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Conservantes Farmacêuticos , Estudos Prospectivos , Lágrimas/fisiologia , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
8.
Cornea ; 40(9): 1132-1140, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-33369937

RESUMO

PURPOSE: NOV03 has a unique dual mode of action to address dry eye disease (DED) associated with meibomian gland dysfunction. SEECASE evaluated the efficacy, safety, and tolerability of NOV03 at 2 dosing regimens compared with a saline comparator in patients with DED. METHODS: SEECASE was a prospective, multicenter, randomized, double-masked, saline-controlled clinical study. A total of 336 DED patients [tear film breakup time ≤5 seconds, abnormal meibum secretion, total corneal fluorescein staining (tCFS) score of 4 ≤ X ≤ 11 (National Eye Institute scale), Schirmer of ≥5 mm] were randomized in a 2:2:1:1 manner to NOV03 4 times daily (QID), NOV03 twice daily (BID), saline BID, and saline QID, respectively. The primary efficacy endpoint was tCFS staining at 8 weeks for both regimens. Secondary endpoints included visual analog scales and the Ocular Surface Disease Index questionnaire for symptom assessment. RESULTS: The study met its primary endpoint, change from baseline of tCFS over control, for both dosing regimens QID and BID (P < 0.001 and P = 0.009, respectively). NOV03 also showed pronounced improvement in various symptoms. For the Eye Dryness Score, changes from baseline were statistically significant compared with those of the control at week 8 [P < 0.001 (QID) and P = 0.002 (BID)]. Benefits on tCFS and symptoms started at 2 weeks after start of treatment and were maintained over the study duration. The effects were dosing schedule dependent. NOV03 was well tolerated with instillation site reactions below 3% in both treatment regimes. CONCLUSIONS: The SEECASE study demonstrated that NOV03 improves signs and symptoms in patients with highly symptomatic evaporative dry eye disease.


Assuntos
Síndromes do Olho Seco/tratamento farmacológico , Fluorcarbonetos/uso terapêutico , Administração Oftálmica , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Síndromes do Olho Seco/etiologia , Síndromes do Olho Seco/fisiopatologia , Feminino , Fluoresceína/administração & dosagem , Fluorcarbonetos/efeitos adversos , Fluorofotometria , Humanos , Masculino , Disfunção da Glândula Tarsal/complicações , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos Prospectivos , Coloração e Rotulagem/métodos , Inquéritos e Questionários , Lágrimas/fisiologia , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
9.
Optom Vis Sci ; 97(9): 676-682, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32932396

RESUMO

SIGNIFICANCE: This study evaluated the effects scleral lens wear has on corneal health using fluorometry and in vivo confocal microscopy. No subclinical changes on healthy corneas of young subjects were observed during 3 months of scleral lens wear. PURPOSE: This study aimed to evaluate the effects 3 months of scleral lens wear has on the corneal epithelial barrier function, dendritic cell density, and nerve fiber morphology. METHODS: Twenty-seven neophytes (mean [standard deviation] age, 21.4 [3.9] years) wore scleral lenses of a fluorosilicone acrylate material bilaterally (97 Dk, 15.6 to 16.0-mm diameter) for 3 months without overnight wear. Subjects were randomized to use either Addipak (n = 12) or PuriLens Plus (n = 15) during lens insertion. Measurements of corneal epithelial permeability to fluorescein were performed with automated scanning fluorophotometer (Fluorotron Master; Ocumetrics, Mountain View, CA) on the central cornea of the right eye and the temporal corneal periphery of the left eye. Images of the distributions of corneal nerve fibers and dendritic cells and nerve fibers were captured in vivo with a confocal laser scanning microscope (Heidelberg Retina Tomograph, Rostock Cornea Module; Heidelberg Engineering, Heidelberg, Germany) on the central and inferior peripheral cornea of the left eye. Corneal measurements and imaging were performed at baseline and after 1 and 3 months of lens wear. RESULTS: The corneal permeability values in natural log, dendritic cell densities, and nerve fiber morphology did not significantly change from baseline to 1 and 3 months of lens wear, for both central and peripheral corneal regions (P > .05). Dendritic cell density at the inferior cornea was higher than the central cornea throughout the study (P < .001). No relationships were observed between each outcome measurements and the saline solution groups (P > .05). CONCLUSIONS: Scleral lens wear for 3 months on healthy cornea of young subjects did not affect corneal epithelial barrier function, nerve fiber, and dendritic cell densities. Buffered and nonbuffered saline solutions impacted the corneal health in similar ways.


Assuntos
Lentes de Contato , Córnea/fisiologia , Esclera , Contagem de Células , Córnea/inervação , Células Dendríticas/citologia , Método Duplo-Cego , Epitélio Corneano/fisiologia , Feminino , Fluorofotometria , Humanos , Masculino , Microscopia Confocal , Nervo Oftálmico/anatomia & histologia , Estudos Prospectivos , Fatores de Tempo , Adulto Jovem
10.
Vet Ophthalmol ; 23(5): 828-833, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32666689

RESUMO

OBJECTIVE: To investigate the effects of acute conjunctivitis on tear film characteristics and corneal sensitivity in dogs. ANIMALS STUDIED: Eight female spayed Beagle dogs (1.5-2 years old, 7.5-10 kg). PROCEDURES: On two consecutive days, one randomly selected eye in each dog received 1 or 375 mg/mL histamine solution to induce mild or severe conjunctivitis, while the contralateral eye served as control. Diagnostic tests were performed in the following order: fluorescein instillation and repeated tear collection over 20 minutes (to determine tear volume [TV] and turnover rate [TTR] by fluorophotometry), Schirmer tear test-1 (STT-1), tear ferning, corneal esthesiometry, and tear film breakup time (TFBUT). RESULTS: Results are presented as median values for severe conjunctivitis, mild conjunctivitis, and control eyes. Eyes with severe conjunctivitis had significantly higher STT-1 (24, 19.5, 17.5 mm/min; P = .002) and significantly lower TFBUT (10.5, 13.5, 15.5 s; P = .002), but no changes were noted in corneal tactile sensation (2, 2.5, 2.5 cm) or tear ferning (grades 2, 2, 2.5). Severe conjunctivitis significantly increased TV by nearly 10-fold (631, 97, 65 µL) initially (reflex tearing), although basal TV returned rapidly (<5 minutes) in all eyes (46, 58, 48 µL). Finally, there was a nonsignificant trend for higher reflex TTR in the conjunctivitis vs control eyes (68, 58, 43%/min). CONCLUSIONS: Experimentally induced conjunctivitis increases tear quantity and decreases tear quality in dogs, but has no impact on corneal sensitivity. Changes in tear film dynamics could affect ocular pharmacology (eg, precorneal retention time), although homeostasis of lacrimal volume and drainage is rapidly restored.


Assuntos
Conjuntivite/veterinária , Doenças do Cão/fisiopatologia , Lágrimas/metabolismo , Animais , Conjuntivite/fisiopatologia , Cães , Feminino , Fluorofotometria/veterinária , Homeostase , Índice de Gravidade de Doença
11.
Ophthalmol Glaucoma ; 3(2): 122-129, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32672595

RESUMO

PURPOSE: To investigate the effects of high-intensity focused ultrasound (HiFU) on aqueous humor dynamics in patients with glaucoma. DESIGN: Comparative, nonrandomized, interventional study. PARTICIPANTS: Adult patients with a diagnosis of open-angle glaucoma or ocular hypertension with suboptimal intraocular pressure (IOP) control despite maximum medical treatment who required further IOP optimization. METHODS: All patients underwent comprehensive ophthalmic examination before aqueous humor dynamics study measurements, including fluorophotometry and digital Schiøtz tonography. All patients received 6 seconds of HiFU therapy. Aqueous humor dynamics studies were repeated 3 months after the treatment (patients had 4-week washout from their glaucoma medication before their aqueous humor dynamics study measurements at baseline and the 3-month visit). MAIN OUTCOME MEASURES: Intraocular pressure, facility of topographic outflow, aqueous flow rate, and uveoscleral outflow. RESULTS: Thirty eyes of 30 patients were included in the study. At the 3-month postoperative visit, the mean postwashout IOP was reduced by 16% (31.7±5.3 vs. 26.6±4.8 mmHg, P = 0.004), and aqueous flow rate was decreased by 15% (2.07±0.73 vs. 1.77±0.55 µl/min, P = 0.05) from baseline. Neither the tonographic outflow facility nor the uveoscleral outflow was significantly different from baseline. There is a 20% risk of treatment failure (those who needed further glaucoma surgical intervention) within 1 month after a single HiFU treatment (n = 6). Only 25 patients (80%) were able to undergo post-treatment washout measurements, and in these eyes, only 26.6% of eyes achieved >20% IOP reduction at 3 months compared with baseline. CONCLUSIONS: We investigated the aqueous humor dynamics effects of a cyclodestructive procedure and specifically HiFU in patients with uncontrolled open-angle glaucoma on maximum tolerated medical therapy. High-intensity focused ultrasound reduced IOP 3 months postoperatively by 16% and aqueous flow decreased by 15% without any significant effect on tonographic outflow facility and uveoscleral outflow.


Assuntos
Humor Aquoso/fisiologia , Glaucoma/cirurgia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Pressão Intraocular/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluorofotometria/métodos , Glaucoma/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Tonometria Ocular , Adulto Jovem
12.
Bull Math Biol ; 82(6): 71, 2020 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-32506271

RESUMO

Many parameters affect tear film thickness and fluorescent intensity distributions over time; exact values or ranges for some are not well known. We conduct parameter estimation by fitting to fluorescent intensity data recorded from normal subjects' tear films. The fitting is done with thin film fluid dynamics models that are nonlinear partial differential equation models for the thickness, osmolarity and fluorescein concentration of the tear film for circular (spot) or linear (streak) tear film breakup. The corresponding fluorescent intensity is computed from the tear film thickness and fluorescein concentration. The least squares error between computed and experimental fluorescent intensity determines the parameters. The results vary across subjects and trials. The optimal values for variables that cannot be measured in vivo within tear film breakup often fall within accepted experimental ranges for related tear film dynamics; however, some instances suggest that a wider range of parameter values may be acceptable.


Assuntos
Modelos Biológicos , Lágrimas/fisiologia , Biologia Computacional , Simulação por Computador , Síndromes do Olho Seco/diagnóstico por imagem , Síndromes do Olho Seco/fisiopatologia , Fluoresceína , Corantes Fluorescentes , Fluorofotometria/métodos , Fluorofotometria/estatística & dados numéricos , Humanos , Hidrodinâmica , Análise dos Mínimos Quadrados , Conceitos Matemáticos , Dinâmica não Linear , Concentração Osmolar , Lágrimas/química , Lágrimas/diagnóstico por imagem
13.
J Ocul Pharmacol Ther ; 36(6): 458-466, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32552217

RESUMO

Purpose: To determine the baseline choroid-retina fluorescence signal in Royal College of Surgeon (RCS) rats of various ages with different degrees of retinal degeneration and assess the persistence of intravitreal nanoparticles. Methods: In RCS rats of age 6, 12, and 20 weeks and Sprague Dawley (SD) rats of age 6 and 20 weeks, baseline eye tissue fluorescence and retinal thickness were recorded noninvasively using fluorophotometry and optical coherence tomography (OCT), respectively. Further, 20-nm carboxylate-modified fluorescent particles were injected intravitreally in the above groups of rats, and the depth-wise fluorescence signal was monitored over 7 days using fluorophotometry and confocal laser scanning ophthalmoscopy (cSLO). Additionally, 200 nm particles of the same material were injected intravitreally into about 7-week-old RCS rats and the fluorescence signal was monitored up to 35 days using fluorophotometry. Results: Reduction in retinal thickness and an increase in choroid-retina and lens baseline fluorescence was observed with increasing age of RCS and SD rats. The 20 nm particles persisted in the vitreous of animals from all age groups for at least 7 days postadministration, irrespective of the differences in retinal thickness. cSLO confirmed nanoparticle persistence in the eye. The fluorescence signal from 200 nm particles persisted for 35 days in the vitreous humor. Conclusions: Choroid-retina and lens autofluorescence monitored using fluorophotometry increase with age. Intravitreally injected nanoparticles can be monitored noninvasively in rats using fluorophotometry and cSLO imaging. Both 20 and 200 nm particles persist in the back of the eye tissues, for several days following intravitreal injection.


Assuntos
Corioide/metabolismo , Nanopartículas/metabolismo , Retina/metabolismo , Degeneração Retiniana/tratamento farmacológico , Animais , Corioide/diagnóstico por imagem , Corioide/efeitos dos fármacos , Sistemas de Liberação de Medicamentos/métodos , Monitoramento de Medicamentos/métodos , Feminino , Fluorofotometria/métodos , Injeções Intravítreas , Masculino , Microscopia Confocal/métodos , Modelos Animais , Nanopartículas/administração & dosagem , Nanopartículas/química , Ratos , Ratos Sprague-Dawley , Retina/diagnóstico por imagem , Retina/efeitos dos fármacos , Cirurgiões/organização & administração , Tomografia de Coerência Óptica/métodos , Corpo Vítreo/metabolismo
14.
Graefes Arch Clin Exp Ophthalmol ; 258(8): 1757-1762, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32388624

RESUMO

PURPOSE: The aim of this study is to evaluate ocular surface morphological and functional changes in patients with neurofibromatosis type 1 (NF1). METHODS: Twenty-eight patients with NF1 and 14 healthy subjects were included in this study. All participants underwent a medical history collection, a complete ophthalmological examination including slit lamp exam and assessment of best-corrected visual acuity (BCVA), corneal sensitivity, and lacrimal function (Schirmer test and fluorescein tear break-up time test). Corneal nerves' morphology and endothelial cells density were evaluated by in vivo corneal confocal microscopy (IVCM). Tear and conjunctiva epithelium samples were collected to evaluate nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF) tear levels and conjunctival expression of their receptors TrkA and p75NTR. RESULTS: Patients with NF1 showed a significant decrease of FTBUT when compared with healthy subjects (p < 0.001). Corneal sensitivity was ≤ 50 mm in 46% of NF1 patients. IVCM showed a significant increase of corneal nerve branching and of corneal endothelial cells density. No significant difference was observed between the two groups on NGF and BDNF tear levels and conjunctival expression of their receptors. CONCLUSION: This study demonstrated the presence of ocular surface changes in NF-1 patients including decrease of tear stability and of corneal sensitivity. Patients with NF1 also showed changes of corneal endothelial cells' density.


Assuntos
Túnica Conjuntiva/patologia , Córnea/patologia , Doenças da Córnea/etiologia , Neurofibromatose 1/complicações , Adulto , Túnica Conjuntiva/metabolismo , Córnea/metabolismo , Doenças da Córnea/diagnóstico , Doenças da Córnea/metabolismo , Feminino , Fluorofotometria , Humanos , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Lágrimas/metabolismo
15.
Curr Eye Res ; 45(8): 897-903, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32066267

RESUMO

PURPOSE: To examine the effectiveness of using meibomian gland (MG) dropout and distortion for dry eye disease (DED) diagnosis in a young population with long-term contact lens (CL) wear. METHODS: Seventy-three CL-wearers and 68 non-CL-wearers (20-28 years old) participated in the study. The diagnosis of DED was based on an ocular surface disease index ≥ 13, and a noninvasive breakup time < 10 seconds or positive corneal fluorescein staining. The MG dropout and distortion in each subject were quantified with non-invasive meibography. Receiver operating characteristic (ROC) curves were created to evaluate the effectiveness of using MG dropout and distortion to determine the presence of DED in CL-wearers and non-CL-wearers. RESULTS: In non-CL-wearers, the MG distortion was significantly higher in DED subjects than in normal subjects (3.83 ± 1.81 versus 1.59 ± 1.04). In CL-wearers, MG distortion was not significantly different (5.12 ± 4.11 versus 5.51 ± 3.15 in normal and DED subjects respectively). The area under the ROC curve (AUC) for MG distortion was 0.783 in the non-CL-wearers, but 0.507 in CL-wearers. In non-CL-wearers, MG dropout was significantly higher in DED subjects than in normal subjects (0.22 ± 0.08 versus 0.15 ± 0.06). In CL-wearers, MG dropout was also significantly higher in DED subjects than in normal subjects (0.29 ± 0.11 versus 0.22 ± 0.08). The AUC for MG dropout used to classify DED was 0.740 in the non-CL-wearers and 0.715 in CL-wearers. CONCLUSIONS: MG dropout was effective in distinguishing subjects with DED from normal subjects in both CL wearers and non-CL wearers. MG distortion can only distinguish DED subjects from normal ones in non-CL wearers, but not in CL wearers.


Assuntos
Lentes de Contato , Síndromes do Olho Seco/diagnóstico , Doenças Palpebrais/diagnóstico , Glândulas Tarsais/patologia , Adulto , Área Sob a Curva , Córnea/fisiologia , Doenças Palpebrais/diagnóstico por imagem , Feminino , Fluorofotometria , Humanos , Masculino , Glândulas Tarsais/diagnóstico por imagem , Concentração Osmolar , Curva ROC , Radiografia , Inquéritos e Questionários , Lágrimas/química , Lágrimas/fisiologia , Adulto Jovem
16.
Int Ophthalmol ; 40(5): 1277-1284, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31981000

RESUMO

OBJECTIVE: To investigate the dry eye symptoms after cataract surgery in MGD patients and their relationships METHODS: The study included 115 patients (115 eyes) with age-related cataract that underwent uncomplicated cataract surgery, and the patients were divided into two groups according to the MGD diagnostic criteria: group A (MGD group) and group B (control group). Schirmer I test (ST-I), tear breakup time (TBUT), and corneal fluorescein staining (CFS) were performed preoperatively and at 3 days, 7 days, 14 days, and 30 days postoperatively. We also measured eyelid meibomian gland morphology, meibomian gland expression, and meibum character scores before and after the cataract surgery. RESULTS: Postoperatively, in group A, TBUT decreased and CFS scores increased significantly. ST-I increased in the early postoperative course but decreased later. The eyelid margin morphology scores and meibomian gland expression scores of group A significantly increased after the cataract operation. Thus, patients with MGD may have a greater chance of developing the dry eye disease after cataract surgery. Cataract surgery may aggravate the signs of MGD, and the severity of MGD may positively correlate with TBUT, CFS, and corneal lesions after surgery. CONCLUSIONS: The characteristics of dry eye after cataract surgery in patients with MGD are different from common cataract patients, changes in the early postoperative phase to the ocular surface were caused by surgical factors, and the damages to epithelial function in the later postoperative phase were mainly associated with the inflammation of the meibomian gland and eyelid.


Assuntos
Extração de Catarata/efeitos adversos , Síndromes do Olho Seco/diagnóstico , Glândulas Tarsais/patologia , Complicações Pós-Operatórias , Idoso , Idoso de 80 Anos ou mais , Síndromes do Olho Seco/etiologia , Feminino , Fluorofotometria , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
17.
Nepal J Ophthalmol ; 12(24): 201-208, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33978614

RESUMO

INTRODUCTION: Corneal autofluorescence (AF) has been recommended as an indicator of diabetic retinopathy. This study was conducted to evaluate corneal autofluorescence in non-insulin dependent diabetes subjects (with and without diabetic retinopathy) and compare the changes with healthy subjects. MATERIALS AND METHODS: In this cross-sectional study, 145 eyes of diabetes mellitus subjects with and without diabetic retinopathy and 34 eyes of normal healthy subjects were included. Diabetic patients were subdivided by the severity of retinopathy based on international clinical diabetic retinopathy disease severity scale. The investigations included fluorophotometric determination of corneal autofluorescence, fasting glucose level (FBS) and glycosylated hemoglobin (HbA1c). RESULTS: The corneal autofluorescence values were significantly higher in moderate NPDR, severe NPDR and PDR when compared with healthy subjects (p<0.001). FBS values and HbA1c were significantly higher in all diabetic groups than the healthy subjects (p<0.001). In linear regression test, corneal autofluorescence seem to be related to duration of diabetes and FBS, but not with age and HbA1c. CONCLUSION: We conclude that the level of corneal autofluorescence is dependent on the severity of diabetic retinopathy. Our study suggests that the formation of autofluorescent products in cornea depend upon the glucose concentration in the aqueous humor.


Assuntos
Diabetes Mellitus Tipo 2 , Retinopatia Diabética , Córnea/diagnóstico por imagem , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Retinopatia Diabética/diagnóstico , Fluorofotometria , Humanos
18.
Burns ; 46(4): 970-973, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31771901

RESUMO

Ocular burns are ophthalmological emergencies, owing to their potentially serious visual complications. Prompt recognition, irrigation and comprehensive examination including fluorescein staining is recommended to optimise outcomes. Burns standards recommend ophthalmological services be available in a 'timely' manner. This paper is a retrospective review of facial burn admissions between November 2017 and November 2018 at the Queen Elizabeth Hospital Birmingham (QEHB), a regional burns centre in the United Kingdom. This study aims to assess referral rates to ophthalmology, timeliness of review and the proportion of patients reviewed within a 24h window. From the data available we also aim to determine the frequency of fluorescein examination. Of 88 patients admitted with facial burns, data was available for 80 patients. The majority (n=77, 87.6%) suffered thermal burns. Twenty-two (27.5%) patients were referred to ophthalmology, and 18 (22.5%) had a documented review. Mean time from admission to review was 45.0h, with 10 (52.6%) patients being seen within 24h. Of 80 patients, 50 (62.5%) patients had no documented fluorescein examination. Further prospective studies are necessary to inform clinical guidelines and optimise management of facial burns.


Assuntos
Queimaduras/terapia , Queimaduras Oculares/diagnóstico , Queimaduras Oculares/terapia , Traumatismos Faciais/terapia , Fluorofotometria/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Unidades de Queimados , Gerenciamento Clínico , Humanos , Oftalmologia , Fatores de Tempo , Índices de Gravidade do Trauma , Reino Unido
19.
Clin Exp Optom ; 103(4): 469-473, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31272130

RESUMO

BACKGROUND: The aim of this study was to investigate the utility of strip meniscometry tube (SMTube) for the quantitative assessment of the tear film, by comparing it to measurements of tear turnover rate using the gold standard method, fluorophotometry. Also, to determine the viability of this test as a diagnostic tool for aqueous deficient dry eye (ADDE), to inform appropriate clinical management. METHODS: Thirty-two participants (15 ADDE; 17 non-ADDE) were recruited. Tear turnover rate of the right eye of each subject was conducted with an automated scanning fluorophotometer and SMTube test was conducted. Tear meniscus height was assessed using a slitlamp biomicroscope and eyepiece graticule. RESULTS: Significant differences between the ADDE and the non-ADDE groups were found for all measures: tear turnover rate 7.9 ± 1.8 versus 19.6 ± 5.9 per cent/minute (p < 0.001), SMTube 3.2 ± 1.1 versus 5.7 ± 2.3 mm (p = 0.001) and tear meniscus height 0.18 ± 0.05 versus 0.23 ± 0.04 mm (p = 0.004). Moreover, significant correlations were found between tear turnover rate and SMTube (rho = 0.78, p < 0.001), tear turnover rate and tear meniscus height (rho = 0.54, p < 0.001) and SMTube and tear meniscus height (rho = 0.47, p < 0.01). Using a receiver operating characteristic curve, SMTube showed a sensitivity of 67 per cent and a specificity of 88 per cent for the diagnosis of ADDE. CONCLUSION: Given its performance, availability, speed and the fact it is relatively cheap, the study shows that the SMTube can be used as an alternative to fluorophotometry to assess tear production. It appears from the results that SMTube is a viable minimally invasive test for the diagnosis of ADDE.


Assuntos
Humor Aquoso/metabolismo , Síndromes do Olho Seco/diagnóstico , Fluorofotometria/métodos , Lágrimas/metabolismo , Adulto , Síndromes do Olho Seco/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Tomografia de Coerência Óptica/métodos
20.
Ophthalmology ; 127(1): 14-26, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31585826

RESUMO

PURPOSE: To evaluate the efficacy and safety of topical cenegermin (recombinant human nerve growth factor) in patients with neurotrophic keratopathy. DESIGN: Multicenter, randomized, double-masked, vehicle-controlled trial. PARTICIPANTS: Patients with neurotrophic persistent epithelial defect with or without stromal thinning. METHODS: The NGF0214 trial, conducted among 11 sites in the United States, randomized 48 patients 1:1 to cenegermin 20 µg/ml or vehicle eye drops, 6 drops daily for 8 weeks of masked treatment. Follow-up was 24 weeks. Safety was assessed in all patients who received study drug. Efficacy was assessed by intention to treat. MAIN OUTCOME MEASURES: The primary end point was healing of the neurotrophic lesion (persistent epithelial defect or corneal ulcer) after 8 weeks of masked treatment. Masked central readers measured neurotrophic lesions in randomized clinical pictures, then assessed healing status conventionally (<0.5 mm of fluorescein staining in the greatest dimension of the lesion area) and conservatively (0-mm lesion staining and no other residual staining). Secondary variables included corneal healing at 4 weeks of masked treatment (key secondary end point), overall changes in lesion size, rates of disease progression, and changes in visual acuity and corneal sensitivity from baseline to week 8. RESULTS: Conventional assessment of corneal healing showed statistically significant differences at week 8: compared to 7 of 24 vehicle-treated patients (29.2%), 16 of 23 cenegermin-treated patients (69.6%) achieved less than 0.5 mm of lesion staining (+40.4%; 95% confidence interval [CI], 14.2%-66.6%; P = 0.006). Conservative assessment of corneal healing also reached statistical significance at week 8: compared to 4 of 24 vehicle-treated patients (16.7%), 15 of 23 cenegermin-treated patients (65.2%) achieved 0 mm of lesion staining and no other residual staining (+48.6%; 95% CI, 24.0%-73.1%; P < 0.001). Moreover, the conservative measure of corneal healing showed statistical significance at week 4 (key secondary end point). Compared to vehicle, cenegermin-treated patients showed statistically significant reductions in lesion size and disease progression rates during masked treatment. Cenegermin was well tolerated; adverse effects were mostly local, mild, and transient. CONCLUSIONS: Cenegermin treatment showed higher rates of corneal healing than vehicle in neurotrophic keratopathy associated with nonhealing corneal defects.


Assuntos
Córnea/inervação , Úlcera da Córnea/tratamento farmacológico , Fator de Crescimento Neural/uso terapêutico , Doenças do Nervo Trigêmeo/tratamento farmacológico , Administração Oftálmica , Adulto , Idoso , Idoso de 80 Anos ou mais , Úlcera da Córnea/fisiopatologia , Método Duplo-Cego , Epitélio Corneano/efeitos dos fármacos , Epitélio Corneano/patologia , Feminino , Fluorofotometria , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fator de Crescimento Neural/administração & dosagem , Fator de Crescimento Neural/efeitos adversos , Soluções Oftálmicas , Proteínas Recombinantes , Resultado do Tratamento , Doenças do Nervo Trigêmeo/fisiopatologia , Acuidade Visual/fisiologia , Cicatrização/efeitos dos fármacos
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